Department of Diagnostic and Interventional Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy.
First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Str., 15562, Athens, Greece.
Radiol Med. 2018 Jul;123(7):538-544. doi: 10.1007/s11547-018-0862-y. Epub 2018 Feb 23.
To describe the clinical and ultrasonography (US) findings of soft tissue hemangiomas, and to compare with the results of histologic diagnosis after US-guided biopsy.
We retrospectively studied the files of 97 patients (48 female, 49 male; mean age, 34 years; range 4-84 years) with soft tissue hemangiomas diagnosed from 2004 to 2011. Mean follow-up was 9 years (range 7-13 years). Clinical presentation included intermittent mild pain associated with a soft tissue swelling/palpable mass in all patients, chronic pain and increased local heat in 29 patients, local swelling and decreased range of motion of the adjacent joint in 45 patients, and all the above symptoms in 23 patients. B-mode and color Doppler US evaluation included the site, location, size, shape, margins, presence of calcifications, echo structure and echogenicity. All patients had US-guided biopsy for histologic analysis.
US-guided biopsy and histology confirmed the diagnosis of soft tissue hemangioma in 92 of the 97 lesions (94.8%). Histologic examination of the remaining five lesions showed nodular fasciitis (two lesions), endometriosis (one lesion), hemangioendothelioma (two lesions); US of these lesions showed variable size, irregular margins, and deep-seated location. Histologically documented soft tissue hemangiomas were most commonly superficial (74 lesions) and arteriovenous (45 lesions). Shape was most commonly oval (fusiform), margins were most commonly not well defined (irregular, hazing but circumscribed), phleboliths were more common in deep-seated lesions, echo structure was heterogeneous, and echogenicity was most commonly hyperechogen and involuting.
Clinical presentation and typical B-mode and color Doppler US findings are adequate for the diagnosis of soft tissue hemangiomas without the need for biopsy and histologic analysis. If any clinical or US doubt, an US-guided biopsy should be performed.
描述软组织血管瘤的临床和超声（US）表现，并将其与 US 引导下活检后的组织学诊断结果进行比较。
我们回顾性研究了 2004 年至 2011 年期间诊断为软组织血管瘤的 97 例患者（48 例女性，49 例男性；平均年龄 34 岁；范围 4-84 岁）的档案。平均随访时间为 9 年（范围 7-13 年）。临床表现包括所有患者均有间歇性轻度疼痛伴软组织肿胀/可触及肿块，29 例患者有慢性疼痛和局部发热增加，45 例患者有局部肿胀和邻近关节活动范围减小，23 例患者有上述所有症状。B 型和彩色多普勒超声评估包括部位、位置、大小、形状、边界、钙化存在、回声结构和回声强度。所有患者均进行 US 引导下活检以进行组织学分析。
US 引导下活检和组织学检查在 97 个病灶中的 92 个（94.8%）证实了软组织血管瘤的诊断。对其余 5 个病灶的组织学检查显示为结节性筋膜炎（2 个病灶）、子宫内膜异位症（1 个病灶）、血管内皮细胞瘤（2 个病灶）；这些病灶的 US 显示大小不一、边界不规则、位置较深。组织学证实的软组织血管瘤最常见于浅层（74 个病灶）和动静脉（45 个病灶）。形状最常见为椭圆形（梭形），边界最常见为不清晰（不规则、模糊但边界清楚），深部病灶更常见静脉石，回声结构不均匀，回声强度最常见为高回声和退行性变。
临床表现和典型的 B 型和彩色多普勒 US 表现足以诊断软组织血管瘤，无需进行活检和组织学分析。如果存在任何临床或 US 疑虑，应进行 US 引导下活检。
